Although SARS-CoV-2 is a viral respiratory infection, some cases of COVID-19 do involve symptoms in the digestive system. This could worsen some symptoms of inflammatory bowel disease (IBD).
People with IBD should take steps to prevent contracting SARS-CoV-2, which causes COVID-19.
They should also be aware of any treatment options that could suppress their immune system, paying special attention to any complications that could arise from the disease.
This article covers IBD and COVID-19, including symptoms, possible risks, prevention tips, and advice.
One study in the Journal of Crohn’s and Colitis notes that the evidence suggests that people with IBD do not have an increased risk of COVID-19.
However, there are some factors for people with IBD to consider.
For example, some treatments for IBD may suppress the immune system, putting a person at greater risk of infections such as SARS-CoV-2. This includes drugs such as:
- immunomodulators, including methotrexate, azathioprine, and 6-mercaptopurine
- Janus kinase inhibitors, such as tofacitinib
- long-term steroids, such as hydrocortisone, prednisone, and methylprednisolone
- anti-tumor necrosis factor biologics, including infliximab, adalimumab, and golimumab
- other biologic drugs, such as vedolizumab and ustekinumab
These drugs may suppress the immune system to help control IBD symptoms. However, this same function may also put people at greater risk of COVID-19 or its complications.
Anyone taking these types of drugs should not stop taking them without consulting a doctor first. Stopping medication abruptly may cause symptom flare-ups.
A study in The Lancet Gastroenterology & Hepatology notes that people whose conditions are stable should continue taking their medications. Anyone who is uncertain about their treatment or who is experiencing a symptom flare-up should contact their doctor.
Anyone who had previously scheduled surgeries or endoscopies should consider postponing these during the COVID-19 pandemic. They should discuss all options with a doctor in each case.
Other people who may be at higher risk of COVID-19 include:
- pregnant women
- people over the age of 65
- people with active-stage IBD who are at risk of malnutrition
- those with other underlying health conditions, such as diabetes or heart disease
A person with IBD who also fits into one or more of these categories may be at greater risk of infection.
Anyone with IBD who starts experiencing symptoms of COVID-19 — such as a fever, a dry cough, or shortness of breath — should call their doctor to discuss their treatment options.
Some people may experience a worsening of IBD symptoms if they have COVID-19.
Although the most common symptoms of COVID-19 occur in the airways, a study in The Lancet Gastroenterology & Hepatology notes that around 4–6% of people with COVID-19 experience digestive symptoms such as nausea, vomiting, or diarrhea.
In people with IBD who already experience digestive symptoms such as diarrhea, this may mean a worsening of symptoms.
Severe complications from the disease may include difficulty breathing that requires medical intervention. Also, in cases where the infection worsens diarrhea, the person may also be at increased risk of malnutrition.
Anyone who experiences symptoms such as shortness of breath, a constant pressure in the chest, or a bluish tint to the skin of their face or lips needs emergency medical care.
Prevention is one of the most important steps for anyone looking to avoid COVID-19, including those with IBD.
Some general prevention tips include:
- washing the hands regularly using soap and warm water, and lathering for at least 20 seconds each time
- coating the hands in an alcohol-based hand sanitizer containing at least 60% alcohol when soap and water are not available
- disinfecting frequently used surfaces in the home, such as door handles, countertops, and handheld items
- using a tissue to cover the nose and mouth when sneezing or coughing, then disposing of the tissue immediately
- avoiding touching the mouth, nose, and eyes
- staying at least 6 feet (2 meters) away from other people while in public areas
In general, it is also important to stay home as much as possible, only leaving the house for necessities such as groceries or medical treatment.
Additionally, the Centers for Disease Control and Prevention (CDC) now recommend that people use cloth face coverings when in public, as an additional step toward preventing the transmission of SARS-CoV-2.
People with IBD should also consider their treatment supply. Many doctors recommend that people with existing conditions have a 90-day supply of their medication at all times. This helps the person avoid going out and ensures that they will have their medications should they need to self-isolate in the home.
Avoiding contact with others is important to help reduce the spread of SARS-CoV-2.
This is especially important for anyone who feels unwell in any way. Symptoms such as a fever, a cough, or general fatigue are signs to stay home, even if a healthcare provider has not tested or confirmed the underlying sickness as COVID-19.
Anyone experiencing symptoms should stay home and contact their doctor for more information. People who are not at high risk of severe complications can call their doctor or schedule a video consultation to discuss treatment needs.
People at higher risk and those experiencing severe symptoms may need to go to urgent care or the emergency room. They should call beforehand, if possible. Calling the facility and explaining the symptoms can help the medical staff take any precautions necessary to prevent the spread of infection.
People experiencing symptoms should also wear a face mask while in public, such as on the way to visiting their doctor.
Treatment options for COVID-19 vary widely. A World Health Organization (WHO) report notes that approximately 80% of people with confirmed COVID-19 have mild-to-moderate symptoms. These cases may be manageable in the home using available medications to ease the symptoms. In these cases, the person should recover within about 2 weeks.
As research in the journal Nature Reviews Gastroenterology & Hepatology notes, around 10% of cases will require hospitalization.
In moderate-to-severe cases, the person may have difficulty breathing. In some cases, they may need supplemental oxygen to keep oxygen-rich air flowing through their lungs.
In the most severe cases, a person may need a mechanical ventilator to keep oxygen in the lungs.
In all cases, a doctor will discuss the treatment options for both COVID-19 and any underlying conditions, such as IBD. In many cases, they will not recommend slowing or stopping any medication a person already takes and finds relief from.
Some groups may be more at risk of severe symptoms related to COVID-19. This includes some people with IBD and those who take drugs that suppress the immune system.
Anyone concerned about their risk of infection should talk to a doctor to discuss their treatment options. Taking the relevant drugs and keeping IBD in remission is generally the priority, and practices such as physical distancing may help reduce the risk of infection.
There is currently no vaccine available for COVID-19, though researchers are exploring the possibilities.